In this article we will discuss how to make a posterior restoration in a simple & predictable way , following a systematic approach .
The initial situation is showing old defective composite restorations related to upper second premolar and first molar .
patient complained of pain & discomfort.
vitality test with Endo ice was checked and the results was positive .
Preoperative occlusal check done using 40 microns articulating paper. This is very important step to ensure a functional & esthetic anatomy avoiding high spots.
rubber dam applied then Caries removal followed by application of caries detector dye as a guide for peripheral seal zone creation.
Caries detector dye applied many times till we obtained stain free peripheral seal zone
cavity design one of the most critical steps for restoration longevity. All margins& angles must be rounded using Arkansas stone & discs. Cusp reduction is mandatory in case of thin cusps (after measurement).
Sandblasting of cavity done using Aquacare device and aluminum oxide 29 microns followed by enamel selecting etching technique.
now the cavity is ready for bonding & composite building.
2 layers of universal bond applied , Light cured after second layer applied.
then thin layer of highly filled flowable composite applied , spread over the entire dentin .
started with first molar , matrix system was applied. The marginal seal was checked.
separation ring was applied distally to compensate for the matrix thickness and create a precise contact. Size & height of matrix is very important step.
Let’s start with proximal walls by snow-blow technique ( small amounts of flowable composite followed by packing of packable composite)
Very important step here to make the height of marginal ridge the same or slightly higher than the marginal ridge of adjacent tooth, to avoid any high spots.
then composite modeling occlusally (cusp by cusp technique) to obtain esthetic & functional anatomy and avoid high spots ( take a reference from sound tooth structure of the same tooth or adjacent tooth )
Then some stains was applied.
The same steps was applied to the second premolar .
finishing and polishing was done by kerr Optidisc & shofu one gloss and eve twist till obtained highly polished restorations.
post operative occlusion print showing the same occlusal contacts as pre operative that’s mean we obtained esthetic & functional restoration.
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